Maternity Benefits for Dependents Not Covered by the ACA

The ACA allows young adults to stay on their parents’ insurance plan until the age of 26. However, it does not guarantee coverage for young women who may become pregnant at this time. While group health plans are required to provide maternity benefits for employees and their spouses under the Pregnancy Discrimination Act of 1978, the law does not address maternity coverage for dependents.

Currently, there is not much data on the number of insurance providers who do not provide maternity benefits for dependents. Since 2008, 2.8 million women between the ages of 15 and 25 have become pregnant. The March of Dimes estimated that the average cost of an uncomplicated pregnancy in 2007 was $10,652. This poses great financial difficulty for young women who are classified as a dependent and do not qualify for Medicaid; especially when considering that prenatal care can significantly reduce medical costs by up to $3,200 in the long run.

Beginning in 2014, maternity and newborn care will be considered an essential health benefit that must be offered by all health plans in the individual and small-group markets. Large group plans, however, are exempt from this mandate.

Advocates for dependent maternity care argue that it is a necessity for young women to have these health benefits, especially with the addition of new preventative care services in the ACA. As of August 1, annual Pap tests, breastfeeding consultation and supplies, and contraceptive methods and counseling are now covered for women at no additional cost. It should be noted that group health plans sponsored by certain religious employers, and group health insurance coverage in connection with such plans, are exempt from the requirement to cover contraceptive services.[1]

The ACA has taken steps in the right direction to provide comprehensive health coverage for women. However, the question of has it done enough for dependent maternity coverage still remains.

[1] A religious employer is one that: (1) has the inculcation of religious values as its purpose; (2) primarily employs persons who share its religious tenets; (3) primarily serves persons who share its religious tenets; and (4) is a non-profit organization under Internal Revenue Code section 6033(a)(1) and section 6033(a)(3)(A)(i) or (iii).